1 Soiled airway tracheal intubation and the effectiveness of decontamination (SATIATED) by paramedics: A randomised controlled manikin study


Background: In more than 20% of out-of-hospital cardiac arrests, the patient’s airway is soiled. 1 2 If the airway cannot be cleared, the patient will die. A new method of clearing the airway, suction assisted laryngoscopy and airway decontamination (SALAD) has been developed, but it’s not known whether this method can assist paramedics to intubate.3 This study aims to determine whether paramedics can intubate a simulated soiled airway more often on their first attempt, using SALAD.

Method: A modified airway manikin, with the oesophagus connected to a reservoir of ‘vomit’ and bilge pump, was used to simulate a soiled airway. The intervention was a brief SALAD training session with a demonstration and opportunity to practice. Participants were randomly allocated into two groups: AAB who made two pre-training intubation attempts and one post-training attempt, and ABB, who made one pre-training and two post-training attempts, to adjust for improvement due to repetition.

Results: 164 paramedics took part in the study. First-pass intubation success with and without SALAD was 90.2% and 53.7% respectively, a significant difference of 36.6% (95%CI 24%–49.1%, p<0.001). The mean successful intubation time for each attempt and patient group (AAB and ABB) was as follows: 61.8 (95%CI 55.8–67.8) and 59.4 (95%CI 53.6–65.1) s on the first attempt, 50.8 (95%CI 45.7–55.9) and 51.5 (95%CI 48.6–54.4) s on the second attempt and 53.5 (95%CI 50.4–56.6) and 46.6 (95%CI 44.0–49.1)s on the third attempt.

Conclusion: In this study, paramedics were able to intubate a simulated soiled airway on their first attempt, significantly more often when using the SALAD technique.

BMJ Open 2019; 9